MyGood Trip, a Telemedicine Intervention for Physical Activity Recovery After Bariatric Surgery: Randomized Controlled Trial.

BACKGROUND: Despite bariatric surgery showing significant weight loss trajectories for many patients, a substantial proportion regain weight after the first year following surgery. The addition of telemedicine to standard care could support patients with engaging in a more active lifestyle and thus improve clinical outcomes. OBJECTIVE: Our aim was to evaluate a telemedicine intervention program dedicated to the promotion of physical activity including digital devices, teleconsultation, and telemonitoring the first 6 months following bariatric surgery. METHODS: This study employed a mixed methods design based on an open-label randomized controlled trial. Patients were included during the first week after bariatric surgery; then, they were randomized into 2 intervention groups: The TelePhys group received a monthly telemedicine consultation focusing on physical activity coaching, while the TeleDiet group received a monthly telemedicine consultation involving diet coaching. Data were collected using a watch pedometer and body weight scale, both of which were connected wirelessly. The primary outcome was the difference between the 2 groups in the mean numbers of steps at the first and sixth postoperative months. Weight change was also evaluated, and focus groups and interviews were conducted to enrich the results and capture perceptions of the telemedicine provided. RESULTS: Among the 90 patients (mean age 40.6, SD 10.4 years; 73/90, 81% women; 62/90, 69% gastric bypass), 70 completed the study until the sixth month (n=38 TelePhys; n=32 TeleDiet), and 18 participants agreed to be interviewed (n=8 Telephys; n=10 TeleDiet). An increase in the mean number of steps between the first and sixth months was found in both groups, but this change was significant only in the TeleDiet group (P=.01). No difference was found when comparing both intervention groups. Interviewed participants reported having appreciated the teleconsultations, as the individualized tailored counseling helped them to make better choices about behaviors that could increase their likelihood of a daily life in better health. Weight loss followed by social factors (such as social support) were identified as the main facilitators to physical activity. Family responsibilities, professional constraints as well as poor urban policies promoting physical activity, and lack of accessibility to sport infrastructure were their major barriers to postoperative lifestyle adherence. CONCLUSIONS: Our study did not show any difference in mobility recovery after bariatric surgery related to a telemedicine intervention dedicated to physical activity. The early postoperative timing for our intervention may explain the null findings. eHealth interventions aiming to change behaviors and carried out by clinicians require support from structured public health policies that tackle patients' obesogenic environment in order to be efficient in their struggle against sedentary lifestyle-related pathologies. Further research will need to focus on long-term interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02716480, https://clinicaltrials.gov/ct2/show/NCT02716480.

Evaluation of Eating Habits and Quality of Life in Postbariatric Surgery Patients and Their Family Members: A Case-Control Study.

BACKGROUND: Obesity is a major health problem worldwide. Today, bariatric surgery is considered as the last option and most effective treatment for severe obesity (BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with metabolic conditions). AIMS: We aimed to evaluate the medium-term effect (>36 months) of bariatric surgery and assess postbariatric nutritional and lifestyle management among Lebanese patients who underwent bariatric surgeries in Jbeil and Keserwan hospitals. METHODS: This study is a quantitative case-control study. The case group includes a couple of patients who have undergone sleeve or bypass surgery 6 months ago and above, along with the main family caregivers. The control group constitutes a couple of obese patients with BMI ≥30 kg/m2 who did not proceed to any surgical intervention with their main caregivers. The final samples consisted of 53 cases and caregivers and 50 controls and caregivers. The assessment was made by an online questionnaire. RESULTS: Compared to obese patients, bariatric patients were less likely to have high energy intake (54% versus 34%, P value 0.012). Moreover, 35.8% of the caregivers of bariatric patients had a low physical activity level compared to those of the control group who had a lower level (70%). In addition, cases' main caregivers (75.5%) had much higher quality of life compared to the cases (56.6%), and also, higher quality of life was seen among the case's main caregivers (75%) compared to the controls (72%). CONCLUSION: In Jbeil and Keserwan regions of Lebanon, there is a lack of postbariatric nutritional and lifestyle management leading to less desirable outcomes in the medium to long term. A set of recommendations are developed based on this study.

Associations of lifetime traumatic experience with dysfunctional eating patterns and postsurgery weight loss in adults with obesity: A retrospective study.

This study aimed to examine the associations of lifetime traumatic experience with presurgery and postsurgery eating pathology and postoperative weight loss in a sample of adult bariatric surgery patients using electronic medical record (EMR) data. Presurgery lifetime exposure to traumatic event, presurgery and postsurgery dysfunctional eating patterns, and post-operative total and excess weight losses were extracted from electronic medical records of 200 adult bariatric surgery patients in 2013 and 2014. Logistic regression analyses were conducted. During their lifetime, 60.5% of the patients (81.5% women, age = 44.4 ± 11.5 years; BMIpre = 44.9 ± 5.5 kg/m2 ) reported that they were exposed to a traumatic event. Before surgery, trauma exposure was associated with impulsive, compulsive, or restrictive eating patterns (OR = 2.40), overeating or disturbed eating (OR = 1.55), and grazing or night eating behaviours (OR = 1.72). After surgery, trauma exposure was associated with lower total weight loss at 6 (OR = 2.06) and 24 months (OR = 2.06), and to overeating or disturbed eating (OR = 1.53) 12 months after surgery. Bariatric surgery candidates with a history of trauma exposure could benefit from closer medical, dietetic, and/or psychological follow-up care to avoid insufficient postoperative weight loss as well as reappearance of dysfunctional eating patterns after surgery.

Randomized controlled trial of a 12-month computerized mindfulness-based intervention for obese patients with binge eating disorder: The MindOb study protocol.

BACKGROUND: Mindfulness-based interventions for healthy behaviors such as exercise and dietary modifications have aroused growing interest. This study aims to test the effectiveness of a mindfulness-based intervention for the reduction of impulsive eating and the improvement of motivation to exercise among obese individuals. METHODS: One-hundred and twenty obese outpatients, aged 18 to 65years, diagnosed with a binge eating disorder, will be randomly assigned to one of the three following groups: mindfulness practice, sham meditation, or treatment as usual control. The tested intervention consists of a 1-year computerized mindfulness-based program. Mindfulness sessions are audio recordings that the patients are asked to listen to, 10min every day. Self-reported questionnaires measuring impulsive eating, motivation to exercise, physical activity level, mood, and mindfulness skills are filled in at baseline, 1, 6, and 12months. Physical activity, calories consumption, and biomarkers are measured with more objective measurement tools at baseline, 6months and 12months. CONCLUSION: Mindfulness, as both a de-automation element and as a moderator of motivation to exercise, can lead to the reduction of impulsive eating and also to an increase in levels of physical activity. These effects could cause weight loss in obese patients suffering from binge eating disorder. TRIAL REGISTRATION: clinicaltrials.gov: NCT02571387.